November 14, 2004

Dangerous as it is, diabetes is increasingly being associated with obesity, which is another fast-spreading epidemic

World Diabetes Day is the primary global campaign for raising awareness on diabetes. It is an occasion to draw public attention to the causes, symptoms, complications and treatment of this serious disorder, which is steadily rising all over the world.

World Diabetes Day was introduced in 1991 in response to concern over the rising incidence of diabetes. This is a day for learning and spreading the message for not only preventing diabetes but also helping people with diabetes to lead a normal life.

The day is celebrated every year on 14 November, as this is the birth date of Fredrick Banting, who along with Charles Best discovered insulin in October 1921.

The World Diabetes Day brings together more than 350 million people worldwide — children, adults, with and without diabetes, healthcare professionals, policy makers and the media. This day is organized in 140 countries who are members of the International Diabetes Federation through healthcare professionals and individuals having an interest in diabetes. Each year a theme is allotted to make it the focus of attention. This year the theme is, “Fight Obesity — Prevent Diabetes”.

According to World Health Organization estimates, there are presently more than 194 million people with diabetes worldwide. It is anticipated that by 2025 this figure will rise to 333 million, if no intervention is done. The developing countries will contribute mainly to the increase, as 75 per cent of these subjects will hail from here. By this time, the Southeast Asian region is anticipated to have about 82 million people with diabetes.

Pakistan had 4.3 million people with diabetes in 1995 and by 2025 the number will increase to 14.5 million. Type 2 diabetes contributes to a major share in the diabetic population. It constitutes about 85 to 95 per cent of all diabetes in developed countries. Type 2 diabetes accounts for 98 per cent of diabetes cases in Pakistan.

Diabetes is a chronic disorder, with the basic defect being either a lack of insulin as the pancreas cannot produce it (type 1 Diabetes Mellitus) or an inadequate action of insulin (type 2 Diabetes Mellitus) also known as insulin resistance.

Overweight and obesity have been identified as one of the major risk factors for the development of insulin resistance and type 2 diabetes. This is directly associated with physical inactivity along with a high-fat, high-energy dense diet. The dramatic rise in the prevalence of diabetes has been mirrored by a worldwide rise in the prevalence of obesity.

WHAT IS OBESITY? It has been described as an accumulation of excess fat in the body, sufficient to harm health. It involves an increase in the size and later the number of fat cells. Obesity is a multi-factorial disease leading to the development of diabetes. It contributes to diabetes, high blood pressure, high cholesterol levels, heart failure, kidney and gallbladder disorders, infertility, birth complications, arthritis and certain cancers. It is also a risk factor for the development of sleep apnea. Genetic factors play some part in the development of obesity — children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

PREVALENCE OF OBESITY: Remarkable increases in obesity have occurred all over the world particularly in the last decade. This is true even for the lower income countries. Obesity and overweight affect about 50-65 per cent of a nation’s population, not only in Europe, USA and Australia but also in Mexico, Egypt, and the black population of South Africa. The highest concentration of obesity is found in the Middle East and some Pacific islands. It has also been observed that the prevalence of obesity is rising by 1.5 - two per cent per year in Asia, Middle East and Latin America.

ASSESSMENT OF OBESITY: Obesity is most commonly assessed by the Body Mass Index (BMI). This is a formula based on an individual’s height and weight. BMI equals weight in kilograms divided by height in meters squared.

The World Health Organization classifies underweight, normal weight, overweight and obese according to categories of BMI.

Waist circumference is another method of determining abdominal obesity. Along with BMI it is the best predictor of obesity related health risks. A waist circumference greater than 40 inches in males and 35 inches in females is abdominal obesity.

Another method is to measure the Waist Hip Ratio. The waist measurement is divided by the hip measurement to get the ratio. A WHR greater than 1.0 in men and 0.8 in women is considered obese. These figures apply more for the western population. The WHO is considering a lowering of these figures for the Eastern world, after obtaining the results from a number of studies.

RISK FACTORS FOR ACQUIRING OBESITY: Anyone can become fat or obese, but it is known that certain groups of people are more likely to become obese. They include people with:

• High-fat, energy dense diet.

• Sedentary lifestyle or physical inactivity.

• Family history.

• Ethnicity.

• Age.

• Stopping smoking.

The basic nutritional needs of most people are approximately 2,000 calories a day for women and 2,500 for men. However, people who are very active, such as professional athletes or manual labourers, may need 4,000 or more. Pregnant women and nursing mothers require about 300-500 more calories/day than women who are neither pregnant nor nursing.

The body cannot store protein or carbohydrate, so excess protein or carbohydrate intake is converted to fat for storage. One pound of fat represents about 3,500 excess calories.

THE PROBLEM OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS

• In 1999, 13 per cent of children aged 6 to 11 years and 14 per cent of adolescents aged 12 to 19 years in the United States were overweight. This prevalence has nearly tripled for adolescents in the past two decades.

• Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight.

• Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.

• Overweight adolescents have a 70 per cent chance of becoming overweight or obese adults. This increases to 80 per cent if one or more parent is overweight or obese.

• The most immediate consequence of overweight as perceived by the children themselves is social discrimination. This is associated with poor self-esteem.

OBESITY AND DIABETES: Obesity has been linked with diabetes for decades. Excess weight is a high risk factor for diabetes in both men and women, especially those with excess abdominal fat. The reason has been attributed to the growing insulin resistance and eventually glucose intolerance.

Fat stores are an important cause of increased free fatty acid and triglyceride in the skeletal muscles. This helps in developing insulin resistance, raising blood glucose levels and chances of developing diabetes. Decreased insulin action increases the breakdown of fat and further elevation of insulin resistance, thus creating a vicious cycle.

The relationship between obesity, insulin resistance and glucose intolerance is well established. It is estimated that half the diabetes cases would be eliminated if weight gain could be prevented. Also the alarming increase in the worldwide prevalence of type 2 diabetes, particularly in developing countries, in minority groups, and in children appears to be mainly related to overweight and obesity.

Obesity is the most prevalent nutritional disorder among children and adolescents in most developing countries. It is increasing in incidence even in developing countries. It is thus a matter of concern as the diseases associated with obesity such as high blood pressure, raised blood fat, liver disease, gall stones, sleep apnea and joint problems are being observed in children also.

Diabetes can be reduced by controlling the main risk factor — obesity. The modifiable risk factors should be given attention from the start of life.

Pregnant women should have an adequate and healthy diet with low fat to produce a healthy baby.

The infant should be introduced to a variety of tastes during weaning. The taste for fruits and vegetables should be developed in early life. High fat and high sugar foods should be avoided. Physical activity should be encouraged in children so that this good habit is carried over to adult life. In adults the diet should be low energy dense, intake of water should be adequate, and appropriate physical activity should be a part of the daily regime.

Avoid the following:

• Stress

• Depression

• Boredom and Frustration

• Excess alcohol consumption

A sedentary lifestyle should be avoided by increasing activity level:

• Aerobic exercise should be performed for at least 30 minutes a day, five times a week.

• Physical activity in general should be increased by walking rather than driving.

• Stairs should be used rather than an elevator or escalator.

• Consumption of food high in fat and sugar should be minimal or a low- calorie, low-fat diet should be preferred.

• Breakfast should never be missed.

• Weight should be monitored frequently.

CHANGING EATING HABITS: Dieting does not mean eating little and only lettuce and sprouts. Dieting is healthy and sensible eating. All foods can be enjoyed in moderation. To achieve success in weight loss, lifestyle has to be changed. This requires cutting back on the number of calories, by eating smaller amounts of foods and choosing foods lower in calories.

Portion sizes, especially of foods high in calories, such as cookies, cakes and other sweets; fried foods, like fried chicken and French fries; and fats, oils and spreads should be limited.

Healthy assortment of foods should be chosen. Bright-coloured (red, yellow, green, and orange) vegetables and fruits, grains (especially whole grains), low-fat or fat-free milk and fish, lean meat, poultry or beans should be included. Foods naturally high in fibre, such as fruits, vegetables, legumes (as beans and lentils) and whole grains are very beneficial. The high fibre content of many of these foods gives a feeling of fullness with fewer calories.

All calorie sources are not created equal. Carbohydrate and protein have about four calories per gram, but all fats, including oils like olive and canola oil, have more than twice that amount (nine calories per gram).

Intake of saturated fat, trans fat, and cholesterol should be as low as possible. All of these fats raise LDL (or ‘bad cholesterol’), which increases the risk for coronary heart disease. Foods high in saturated fats include high-fat dairy products (like cheese, whole milk, cream, butter and regular ice cream), fatty fresh and processed meats, the skin and fat of poultry, lard, palm oil and coconut oil. Trans fat can often be found in processed foods made with partially hydrogenated vegetable oils such as vegetable shortenings, some margarines (for example, stick margarines that are hard), crackers, cookies, candies, snack foods, fried foods and baked goods.

Alcoholic beverages, should be taken in moderation (no more than one drink a day for women, and no more than two drinks a day for men). Alcoholic beverages supply only calories but few nutrients.

INCREASING PHYSICAL ACTIVITY: Most health experts recommend a combination of a reduced-calorie diet and increased physical activity for weight loss.

In addition to helping to control weight, physical activity decreases the risk of dying from coronary heart disease and reduces the risk of developing diabetes, hypertension and certain cancers. Researchers also have found that daily physical activity may help a person lose weight by partially lessening the slow-down in metabolism that occurs during weight loss.

Exercise does not have to be strenuous to be beneficial. And some studies show that short sessions of exercise several times a day are just as effective at burning calories and improving health as one long session.

To lose weight and to maintain a healthy weight after weight loss, many adults will likely need to do more than 30 minutes of moderate to intensive physical activity daily. The important message for leading a healthy life for obese people, is to bring about a behaviour change related to diet and exercise. Weight loss reduces health risks in the obese. Because obesity is a condition requiring continuous attention, the behaviour change required for maintaining weight loss must be life long.

The twin epidemics of obesity and diabetes already represent the biggest health challenge of the 21st century. A global effort is warranted to transform diets and encourage more physical activity to combat this ever-increasing burden. The time to think is gone, now is the time TO ACT.

Please Visit our Sponsor (Ads open in separate window)